Confusion over just how many Bexar County residents have died as a result of COVID-19 is likely to persist as the count by state health officials is significantly larger than what the San Antonio Metropolitan Health District is reporting.

Metro Health has reported 380 deaths related to COVID-19 as of Tuesday. But in a category titled “Fatalities by County of Residence,” the state’s official COVID-19 dashboard showed 646 such deaths through Tuesday.

Metro Health said the discrepancy stems from the fact that it reports the deaths only of people who are confirmed to be Bexar County residents with a positive COVID-19 test on file. Local officials say the state’s numbers include people who died in local health care facilities but resided elsewhere. There’s also a lag between when deaths are reported to the state and when local governments are notified.

Of the 266 deaths logged by the state as COVID-19-related and not reported in Metro Health’s numbers, 177 are not currently in Metro Health’s database because the death certificates have not been received yet by the City Clerk’s office, Metro Health officials said. 

Anita Kurian, Metro Health’s assistant director and head of communicable diseases, said that because hospitals and funeral homes report deaths to the state before the state reports them to local governments, the state will always be in a position to report some deaths before the county.

Once a death is reported to the City Clerk’s office, the health department then investigates to determine whether the deceased was a Bexar County resident or someone from another county who came to here for treatment, Kurian said. Metro Health does immediately report local deaths confirmed to the health department that can be verified, such as deaths reported by long-term-care facilities where a county resident died, without waiting for state confirmation.

In its reporting, the state uses death certificate information as provided by either a hospital or funeral home and registers the information in its database within 10 days of a person’s death, according to state law.

If the hospital or funeral home reports the death occurred in Bexar County but does not have a correct home address for the deceased person on file, the death is reported as a Bexar County death even if the person was a resident of a different county, Kurian said. The state cannot change the designated county of the deceased unless a physician or funeral director requests to have the certificate amended. 

Of the 177 people for whom Metro Health hasn’t yet received a death certificate, 122 have confirmed positive COVID-19 lab tests within the Metro Health system, Kurian said. The 55 other deaths are currently under investigation to confirm that the cause was COVID-19 and are being discussed with DSHS officials.

The remaining 89 deaths are cases in which people either haven’t been confirmed as Bexar County residents or did not have documentation of a positive COVID-19 test and thus will be left out of Metro Health totals, Kurian said. 

Mayor Ron Nirenberg said that while the discrepancies are confusing, “overall trends remain the same, which is that we have an extreme number of cases in this community, it’s spreading, and a lot of people have died.”

“There’s going to be differences, especially when there is such a head-spinning discrepancy between the standards at the state level and the local level across the country,” Nirenberg said. “And it does appear, especially as we’ve talked about things like antigen tests [and whether they are being counted as positives], that there’s an undercount of positive cases at the state and an overcount of deaths at the state.”

Roseanna Garza reports on health and bioscience for the San Antonio Report.